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NEW QUESTION: 1
Arthur Dace, a plan member of the Bloom health plan, tried repeatedly over an extended period to schedule an appointment with Dr. Pyle, his primary care physician (PCP). Mr. Dace informally surveyed other Bloom plan members and found that many people were experiencing similar problems getting an appointment with this particular provider. Mr. Dace threatened to take legal action against Bloom, alleging that the health plan had deliberately allowed a large number of patients to select Dr. Pyle as their PCP, thus making it difficult for patients to make appointments with Dr. Pyle.
Bloom recommended, and Mr. Dace agreed to use, an alternative dispute resolution (ADR) method that is quicker and less expensive than litigation. Under this ADR method, both Bloom and Mr. Dace presented their evidence to a panel of medical and legal experts, who issued a decision that Bloom's utilization management practices in this case did not constitute a form of abuse. The panel's decision is legally binding on both parties.
Different types of compensation arrangements in managed care plans, from fee-for-service (FFS) arrangements to capitation arrangements, lead to different types of fraud and abuse. From the answer choices below, select the response that identifies the form of abuse in which Bloom is allegedly engaging, according to Mr. Dace's complaint, and whether this form of abuse is more likely to occur in FFS compensation arrangements or in capitation arrangements.
A. Type of abuse underutilization Type of compensation arrangement FFS arrangement
B. Type of abuse underutilization Type of compensation arrangement capitation arrangement
C. Type of abuse overutilization Type of compensation arrangement FFS arrangement
D. Type of abuse overutilization Type of compensation arrangement capitation arrangement
Answer: B
NEW QUESTION: 2
You are a project manager responsible for constructing a new sports arena in preparation for upcoming Olympics. Construction begins on a project over a year ago. Stakeholders of the project want a status report on the performance of the project to the date. You have obtained the following measurement:
BAC=500, ETC=200, PV=500, AC=200, EV=300, CPI=1.5
You believe the type of variances that have occurred on the project to date to be atypical, and except these variances to continue. Based on the information above what will be the VAC for the project?
A. 133.33
B. 0
C. 333.33
D. 1
E. 166.67
Answer: E
NEW QUESTION: 3
Which of the following actions can be performed by using the principle of separation of duties?
A. Reducing the opportunity for fraud
B. Conducting background investigation
C. Developing job descriptions
D. Identifying critical positions
Answer: A